The Country Profile that follows will focus on Population and Development, Reproductive Health, and The Position of Women in Egypt. Related statistics are available under the following link: Statistics.

Population and Development in Egypt

Economically, the Arab Republic of Egypt is considered a lower-middle income country. It relies on remittances from Egyptians working abroad, revenues from the Suez Canal and oil, as its main sources of income. Economic growth has been robust in the late 1990s, but suffered considerably from the results of 11 th September 2001, regional imbalances and hesitant steps in the field of economic policies. Following a normalization after the Iraq war, economic growth picked up and reached 4,4% in 2004. It is, however, struggling to compensate for growth of the potential workforce and unemployment remains high as a consequence (10.6% in 2004).Currently, per capita income is estimated at US$ 3,793/year. Income distribution is highly skewed but improving, and overall poverty is decreasing as a result.
In 2000, it was estimated that 17% of total population was poor, as compared to 24% in 1990. Regional differences are pronounced though: poverty tends to be concentrated in rural Upper Egypt , poverty in rural parts of the NileDelta is decreasing, and urban poverty is on the rise. In some governorates in Upper Egypt , up to 50% of population is considered poor. Generally speaking, poverty is shallow and social safety nets, like social pensions and subsidies on bread, protect most poor from absolute destitution.		Source: Ministry of Planning & UN (2004)
Geographically, Egypt occupies the northeastern corner of the African continent and the southwestern tip of Asia . It has an estimated population of 70,5 million (2005) , and covers an area of approximately 1 million km 2 that is mostly desert. Only 8% of Egypt 's total surface is inhabited, with most people living in the Nile Delta and the narrow Nile Valley. With an average of 869 persons/km 2, population density in these inhabited areas is extremely high. Egypt is administratively divided in four regions; the urban governorates, Lower Egypt, Upper Egypt and the frontier governorates. Almost half of Egypt 's total population lives in Lower Egypt while over a third lives in Upper Egypt.
		Source: UNDP (2004)

Currently, population growth stands at 2.1% a year and 38% of population is under the age of 15 years. Population growth is expected to decrease to 1.4% in 2017, by which time total population is projected to have reached 88.8 million.

Source: UNDP (1990), UNDP (2004), UN (2005)	Source: FAO Database
Egypt 's Human Development Index has risen from 0.438 in 1975 to 0.577 in 1990 and 0.653 in 2002. The Human Development Index is calculated on the basis of life expectancy, literacy levels and per capita income. Average life expectancy has risen from 62 years in 1987 to 70.1 years in 2002 . The literacy rate in people over 15 years old has increased from 46.7% in 1990 to 69.4% in 2002 and per capita income has risen from US$2,278 in 1990 to US$3.793 in 2002.
	HDI Source: UNDP (2004)

The steady improvement has pulled Egypt from the low to the medium category of human development. At the Millennium Summit held at the UN in 2000, the Egyptian Government agreed to achieve further progress in key development areas by 2015. Halving extreme poverty, achieving universal primary education for girls and boys, reducing under-five mortality by two-thirds, reducing maternal mortality by three-quarters, and ensuring environmental sustainability are but 4 of 8 so called Millennium Goals (MDGs) that were agreed upon in New York. Population pressure and population growth are a major challenge facing Egypt in its efforts to achieve the MDGs. Currently, Egypt ranks as the 16 th most populous country in the world. Political leaders are well aware of the impact a large population has on socio-economic circumstances and the challenge to ensure that population growth does not become an obstacle to achieving the MDGs. Indeed, the underlying contextual determinants of several evolving development issues in Egypt are population related. The perpetuation of poverty, increasing unemployment rates among youth and women, food shortfalls, the fragmentation of cultivable land, high rates of illiteracy (especially among women), gender gaps in educational enrolment and dropouts, the persistence of unmet needs in reproductive health & family planning services, increasing trends of urbanization, shortages in housing and water resources and environmental degradation are all predisposed and compounded by the nature of Egypt's population growth and composition. The explicit realization of the detrimental impacts of population issues on sustainable development by policymakers and planners in Egypt has greatly shaped the political commitment to invest increasing efforts to address population issues within the ICPD/MDGs operational framework. Hence, the Government of Egypt has reaffirmed its commitment to mobilize resources to advance reproductive health services and rights, not only as a means of implementing poverty reduction strategies, but also as a factor for curbing population problems that inhibit the sustainability of the development process.

Conclusion

Population pressure in Egypt is very high and has a negative impact on a range of socio-economic issues. Although annual population growth is decreasing, Egypt 's population is projected to continue growing over the next couple of decades. Egypt 's government is well aware of the strain this will put on the sustainability of development.

Egypt 's government is committed to reducing population growth. Meanwhile, policies need to be adequate to deal with existing and projected population numbers. This requires the availability of accurate and reliable population data that can be used for planning. At present however, Egypt has limited capacities in this area and UNFPA is supporting Government to enhance utilization of population information for policy dialogue and integrated development planning.

* relevant statistics

Reproductive Health in Egypt

Reproductive health concerns everyone, everywhere, and at every stage of life. It is fundamental to the social and economic development of communities, economies and nations. Reproductive health also reflects some of the basic inequalities in society, the inequalities of wealth and gender. This section of the brief will focus on 5 reproductive health topics: 'Family Planning', 'Maternal Health', 'Infant Health', 'Female Genital Mutilation' and 'HIV/AIDS'.

Family Planning

Egypt has had a strong and successful government-led national family planning (FP) program since the 1960s. It has invested heavily in making FP more available and accessible. Ninety-five percent of the population is now living within 5km of a primary health center where contraceptives are available at a subsidized rate. To encourage people to make use of the available FP services, the State Information Service has been conducting a public information and education program through the mass media since the mid-1980s . Government has long provided FP services through a vertical program. Recently, however, the Ministry of Health and Population (MOHP) has decided to implement a Health Sector Reform Program (HSRP) offering an integrated package of reproductive health (RH) services. The HSRP is still under development and only implemented on a pilot basis in a few selected governorates.

At present, FP services are widely available in both the public and the private sector. Inspite of the relatively high cost of services in private sector clinics, they are often the preferred choice. Women perceive them to be more client-friendly and luxurious. Nevertheless, the quality of public sector clinics has increased dramatically over the last decade, due to training of staff, increased availability of contraceptive methods and refurbishment of premises. As a consequence, reliance on the public sector as a source of FP-methods has been increasing nationwide. It was the source of contraception for 55.6% of contraceptive users in 2003, as compared to 44.5% in 1995.

Notwithstanding recent improvements, the quality of service provision is not yet optimal, neither in the public sector nor in the private sector. Information exchange between users and service providers is usually inadequate, with only 58.6% of women in private clinics and 50% of women in public sector clinics receiving counseling with respect to alternative contraceptive methods and associated side-effects.

In spite of its drawbacks, the Egyptian FP-program has proved successful. Progress is reported with respect to all related indicators (i.e: average age at first marriage, average age at first birth, contraceptive prevalence rate and total fertility rate). In 2003, it was estimated that 90% of the total need for family planning was met . As a general rule, one may conclude that FP is more successful in Urban and Lower Egypt than in Upper Egypt and the Frontier Governorates. In the latter two regions, total fertility rate is higher because women marry at a younger age, conceive at a younger age and are less likely to utilize contraceptives than their counterparts in Lower and urban Egypt.

Total Fertility Rate (TFR) at the national level has been slowly declining from 5.3 live born children per woman in 1980 to 3.2 in 2003. The average number of children that Egyptian women would ideally want to have has been stable around 2.8 or 2.9 children per women, since 1988 . This is far above replacement level and it is necessary to continue emphasizing the desirability of a two-child family if Egypt is to achieve stabilization of its population size.

TFR has decreased because the 'average age at first marriage', the 'average age at first birth' and the 'contraceptive prevalence rate', have all increased. Currently, approximately 25% of girls get married before the age of 20 and median age at first marriage among women between the ages of 25-29 is now 20.9 years. One may therefore conclude that the average age at first marriage is increasing, since older women (those currently between the ages of 45-49) had a median age of 18.7 years at first marriage.

Source: DHS 2003

The age at first birth has undergone a noteworthy rise as well; with respectively 39% and 25% of women aged 45-49 and women aged 20-24 becoming a mother before reaching 20 . In 2000, it was estimated that 7.2% of the cumulative total fertility rate in Egypt was due to women under 20 becoming mothers. Pregnancy before age twenty is associated with higher levels of maternal and infant deaths and morbidity . In addition, adolescent fertility could result in a whole host of adverse outcomes that impact negatively on the well-being of young people and their children. These include a higher probability of drop-out from education and a lower level of participation in economic activity. These outcomes severely curtail the opportunities available to young adults. Women in particular suffer from these consequences. Contraceptive Prevalence Rate (CPR) is up from 47.6% in 1991 to 60.0% in 2003, with 57% of married women (15-49 years old) depending on modern methods and 3% using traditional methods. The IUD (36.7% of married women 15-49) is the most frequently used method, followed by the pill (9.3%) and injectables (7.9%). Although increasing, the CPR in Upper Egypt and the Frontier governorates is still relatively low. This could be connected to less available resources at clinical level, lower female literacy levels, less female employment, and a cultural preference for large families.

Maternal Health

Government, international donors, and NGOs have invested heavily to increase the availability and accessibility of maternal health services, improve the quality of obstetric care, increase access to family planning, educate women and families about seeking prompt medical care for problems during pregnancy and labor, and train traditional birth attendants (dayas) to refer women with obstetric complications. Maternal Mortality Rates are decreasing as a consequence, and Egypt is well on track to reach the Millennium Development Goal of reducing the MMR to 21/100,000 live births in 2015 (a 3/4 reduction). The MMR was 68/100,000 live births in 2003 as compared to 84/100,000 in 2000 and 96/100,000 in 1997. Regional differences are stark though, with MMR being lowest in urban governorates (48/100,000 in 2000) and highest in frontier governorates (120/100,000 in 2000).

The utilization of maternal health care services (pre-, peri- and postnatal) has dramatically improved; antenatal and perinatal coverage in particular. The percentage of births in which the mother reported receiving any antenatal care rose from 39% in 1995 to 69% in 2003, and the percentage of births having regular antenatal care (i.e. at least 4 visits) rose from 28% in 2000 to 56% in 2003. Moreover, 69% of deliveries were assisted by medical personnel in 2003 (almost always a doctor). In 1995, only 46% of deliveries were assisted by medical personnel.

Tetanus Toxoid vaccinations are also more frequent now than in the past. Coverage increased from 72% in 2000 to 78% in 2003. Tetanus injection are almost universally taken at public sector health centers and the MOHP has stressed the importance of using this contact with pregnant women to encourage them to obtain regular antenatal care and to discuss the use of family planning. In practice however, only 29% of women reported that they were encouraged to obtain antenatal care and no more than 15% said that family planning had been discussed.

Post-natal care is very important for the mother and her child, particularly when the birth is not assisted by medical personnel. It is generally recommended that mothers receive the first postnatal checkup within 2 days of delivery in order to detect problems that may lead to maternal death. However, only 42.6% of women in Egypt reported having received postnatal care (most of them, 70% within 2 days of delivery).

All residential categories shared in the improvements in maternal health indicators between the 2000 and 2003. Rural areas, however, continue to lag behind urban areas in both antenatal care coverage (resp. 60.4% versus 82.9%) and in medically-assisted deliveries (resp. 59% versus 86.7%). Maternal health care coverage in rural Upper Egypt is lowest with only 50.3% of women getting antenatal care and no more than 47.6% of deliveries being medically assisted. Moreover, the quality of care in Upper Egypt lags behind with respect to care in Lower Egypt, where blood analysis, urine analysis, iron supplementation, and measurement of nutritional status and blood-pressure are 10 to 20% more common.

Infant Health

The national Infant Mortality Rate (IMR) stood at 38/1,000 live births in 2002 as compared to 44/1,000 in 2000 and 68/1,000 in 1992. Regional differences were marked, with IMR being lowest in urban governorates (26.3/1,000 in 2003) and highest in rural governorates, especially in rural Upper Egypt (58.3/1,000 in 2003).

Mortality level are inversely associated with the mother's educational level, with an IMR of 57.3/1,000 for mothers with no education against 28.6/1,000 for mother that have at least completed secondary school. Similarly infant mortality decreases dramatically with wealth. As expected, mortality among infants born to young mothers (<20years) is much higher then for mothers 20-29 (resp. 60.4 versus 41.0).

Female Genital Mutilation

One of the most prevalent forms of violence against girls is the traditional practice of female genital mutilation, also known as female genital cutting (FGM/C). This practice is carried out both by Egyptian Muslims and Christians and has been at the forefront of the public health discourse for the past ten years. Up to 97% of ever-married women have been circumcised. In 1996, the Minister of Health issued a Decree prohibiting doctors from carrying out FGM/C. Although attitudes towards the practice have started to change modestly, especially among young people, the practice continues in many parts of the country due to embedded socio-cultural beliefs; it makes girls eligible for marriage, it moderates a woman's sexuality, it is sanctioned by religion and it contributes to a woman's hygiene. The DHS 2003 revealed that 71.1% of married women still feel that female circumcision should be continued. Seventy eight percent of married women had already circumcised their daughters or planned to do so in the future as compared to 88% in 1995.

The evidence is that FGM/C increases the chances of severe gynecological problems. Over half of all circumcisions are performed by a trained doctor (52%), while 9% are carried out by a nurse and the remainder are performed by a traditional birth attendant (Dayas). One growing concern is that the individual medical professionals may find it lucrative to continue to offer their services and refuse to stop carrying out operations in spite of the government's decree. Indeed the Doctors Syndicate is one national institution which maintains that there are legitimate reasons for conducting FGM/C procedures on healthy young girls. On the other side, a national FGM taskforce was established in 1994 which included a group of advocates and NGO representatives whose community-based interventions and initiatives over the years represent a sustained commitment to ending this form of violence against girls. Similarly, the National Council for Childhood and Motherhood has launched a large programme in 120 villages, with the objective of making them free of the practice and using this as a model that communities may follow nationwide.

HIV/AIDS

Egypt is considered a low prevalence country with regard to HIV/AIDS. To date, a total of 2,115 people have officially been reported HIV-positive since 1986. There is, however, no adequate surveillance system in place and the true extent of the epidemic is not known. WHO/UNAIDS estimates the number of people living with HIV/AIDS at 12,000. Irrespective of the accuracy of these figures, all sides in the debate agree that there has been a rise in HIV cases in Egypt since 1991. Of the 2,115 official HIV/AIDS cases, 80% are male. The predominant mode of known HIV infection are; sexual intercourse, accounting for 64% of cases, mostly though heterosexual transmission. Infection through infected blood accounts for 31% of cases while mother-to-child transmission seems to be minimal. Factors which may contribute to the potential spread of the illness are prevalent in Egyptian society, with some people having multiple sexual partners, high prevalence of STIs in high risk-groups, high prevalence of reproductive tract infections (RTIs) in women of the general population, an estimated one-third of young males and one-fourth of young females having pre-marital sex, a very low rate of condom use, poor education, unemployment, increasing age at first marriage, poverty, disempowerment of women and high rates of mobility.

Conclusion:

Although regional differences are pronounced, Egypt is making progress in the field of reproductive health, nationwide. However, the quality of services needs to be improved, neglected groups need to receive appropriate attention, and greater efforts are required to address both the constraints and gaps in provision of comprehensive reproductive health care in Egypt , including stronger coordination mechanisms among various stakeholders and the need for more effective partnerships with civil society and the private sector. The health sector reform is paving the way for an integrated family practice approach and aims to provide easy access to affordable basic health services to all Egyptian; rich & poor, urban & rural or young & old.

* relevant statistics.

Position of Women in Egypt

Women are the backbones of their families, caregivers of young and old, stewards of natural resources and pillars of community life. They can and must play a powerful role in reducing poverty and fostering sustainable development. This is emphasized in a recent Millennium Project expert report.

For more than 30 years, UNFPA has been in the forefront of bringing gender issues to wider attention, promoting legal and policy reforms and gender-sensitive data collection, and supporting projects that empower women economically and politically. The Fund promotes the human rights of women and works to improve their status at every stage of life .

Egypt 's outward commitment to equal rights for men and women is exemplary. Domestic law guarantees women's equality, enshrined in article 40 of the Constitution which states that citizens "are equal in front of the law and equal in rights and duties. There shall be no discrimination between them based on gender, origin, language or belief". Reflecting this egalitarian spirit, the country has ratified the seven main Human Rights instruments including the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) on 18 September 1981. Upon ratification, Egypt made reservations to articles 9 (2), 16 and 29 pledging compliance provided that it does not run counter to the Islamic Sharia law. Article 16 concerns women's rights within marriage and family and Article 9(2) concerns the equal right of men and women to pass their nationality to their children. In 2004 the government amended the Nationality Law allowing gender equality regarding the right to pass on the mother's nationality to her children in cases where the father is a non-Egyptian.

In spite of concerted efforts to support women's rights in society, the CEDAW Committee notes that the "persistence of patriarchal attitudes and stereotypical behaviour with respect to the role of women and men in the family and society limit the full implementation of the Convention" . Hence, there is a dearth of opportunities for most Egyptian women to fulfill their potential, characterized by numerous cultural barriers in a male-dominated society, leaving the majority of women lacking the self-confidence and support to participate fully in the communities in which they live. As a consequence of this dichotomy, gender disparities in Egypt are pronounced. In view of this observation the CEDAW Committee has urged the GoE to pursue awareness-raising programs targeted specifically at men to change their attitudes. Although gender disparities in Egypt are diminishing, women continue to be denied equal access to education and employment. Women and Education

Although gender disparities in education have been persistent, they are improving rapidly due to considerable efforts exerted by the government over the last fifteen years. In 2003, the net enrollment rate in primary education was 91% for girls and 94% for boys. The ratio of females to males in secondary education increased from 77% in 1991 to 99.7% in 2000. Although the gender gap in education might be eliminated at a national level soon, the target might not be met in rural parts of Upper Egypt and the Frontier governorates where poverty perpetuates the gender disparities and limits enrollment of girls.

Women and Literacy

Illiteracy among adult women is relatively high; 40.6% (2004), as compared to 30.6% (2002) in the total adult population. Literacy levels among younger generations are however increasing, while the gender gap in this group is steadily decreasing. Literacy among young men (15-25 years) increased from 71.2% in 1986 to 83.2% in 2001, while literacy in young women (15-25 years) increased from 51.3% to 76.4% in that same period.

Women and Employment

Culturally, women are seen primarily as dependents and are expected to be the principal child care providers in the family, while in times of high unemployment women are expected to step aside to leave the work to the men. In this respect the preponderance of early marriage of teenage girls is another feature of the cultural fabric of Egyptian society which curtails women's opportunities, and the CEDAW Committee has requested the GoE to consider modifying the legal age of marriage as part of its duty to reconcile the domestic law and practice with its international obligations. There is also an assumed gender division of labour, where public and government work is seen as more befitting of a woman, while the private sector is seen as a man's domain. At the same time Egyptian laws and regulations prevent women from assuming certain jobs, since women are barred from working at night, except under certain circumstances and in certain sectors. Moreover, regulations that were put in place to protect women workers, such as the right to three months paid maternity leave and the right to a nursery in firms with more than 100 workers, are likely to affect employers' decisions to employ women. At the same time, the absence of regulations and the non-enforcement of others encourages non-compliance by private firms with womens' maternity leave entitlements, thus making women hesitant to join the private sector.

Slowly, but gradually, women are winning ground when it comes to their participation in the Egyptian labour market. Between 1976 and 1996, the female share in the labour force increased from 7.3% to 15.3%. An important factor behind this gender-based shift in the labour force structure is the increasing number of educated females. This has led to higher rates of employment of females holding secondary and above intermediate education certificates. It also attributed to more employment of married females in the age of 30 years and above.

Female participation in Egypt 's economy is however still lagging behind and unemployment is much higher for women than for men. Unemployment rates for women increased from 14.4% in 1990 to 22.6% in 2001, as compared to an unemployment rate of 5.6% for men in 2001.

This phenomenon has significant impact on the development indicators, as women are more likely than men to use their incomes to improve their children's nutrition, health care and schooling.

Conclusion

Socio-economically, women occupy a subordinate position in Egyptian society. Their position is however improving. The gender gap in education is diminishing but not yet closed. Moreover, a substantial part of women are still illiterate and unemployed. Poor women in particular , lack self-confidence and support to fully participate in their communities, because patriarchal attitudes and stereotypical behaviour with respect to the role of women and men persist. It is recommended to pursue awareness-raising programs targeted specifically at men to change attitudes, and to empower women by improving their education status and improve their position in the labour market.

* Relevant Statistics.

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